Guest post: But they look like you and me!

When it comes to attitudes to mental health,
things are getting worse. Despite the high-profile campaigns, stigma and
discrimination against people with mental health problems seem to be on the rise.
Part of the reason may be that our campaigns are promoting the wrongmessage.
The way we often address stigma is to promote the idea that mental health
problems are illnesses. The rationale
is noble. Rather than give the impression that someone is weak or
blameworthy, isn’t it surely better to say they are sick?

The danger of this is that the idea of something
going wrong with people’s brains can be scary and alienating. Put this together with the ‘1 in 4’ idea
- that one in four of us will suffer ‘mental illness’ at some point - and it can
add up to a frightening message: there’s a dangerous disease out there that
might strike at us any time.

However, we all have dark moments, and many
argue those are on the same spectrum as the emotional distress that attracts
‘mental health’ diagnoses. As clinical psychologist Anne Cooke said recently,
‘there is no “us and them”, no people who
are ‘normal’ and people who are “mentally ill”. We’re all in this together.’

Just as important as the message though, is
the question of whether the wide-focus approach of anti-stigma campaigns (posters
on the tube, etc.) is the most effective way to go about things. So what
messages should we be giving and who are the most important groups to reach?

A study that
I and some colleagues have recently published investigated both the message and
the people who receive it. In particular, we looked at the importance of communication
during key stages of children’s development and we considered how parents talk
to their primary-school-aged children about mental health.

Our central finding was that, while parents
were happy and open when chatting to their children about mental wellbeing, the exact opposite was true
when communicating about mental illness.
The more parents thought of a particular issue as being about mental illness,
the more they conceptualised it as happening to other people and the less they talked
to their child about it. Even when asked directly, parents tended to avoid the
subject. Comments often inadvertently reinforced the us and them distinction: ‘He’s met a girl who is bipolar but I don't
think he realised…. they look like you and me’.

Interestingly, the parents in the study all
said that they wanted to be open and honest with children about mental health
problems. The mismatch with what they actually did led to some interesting contradictions.
For example, parents believed that their children were understanding and accepting
of mental illness. However, they also talked about children’s lack of
understanding and the probability of them being upset as reasons to avoid talking
about it. Most poignantly, these confusions were even true of parents who had
themselves experienced mental health problems:

‘I don't think you put your head in the sand and
pretend it’s not there. … I got post-natal depression… and Daisy [name changed]
went through that. Now, I’ve never told her I had depression.’

The way parents talked to their children
was powerfully influenced by the way that their own parents had talked to them.
Often people wanted to be more open than their own parents had been, but didn’t
manage it. I wonder if this affects many families. There was a sobering moment
halfway through the research when I realised that this issue had been a part of
my own childhood. I remember half-explanations, pointed looks, and sad voices when
people mentioned a beloved family member who had died before I was born. Much later
on, I discovered that they had died by suicide, following a period of intense
mental distress. When I plucked up the courage to broach this with my family, I
found that my parents hadn’t talked to me about it partly because they felt
they hadn’t really understood what had gone on. They put this down to silence
on the subject on the part of their own parents. Taboo and lack of
understanding had passed down through the generations.

Why is it important to know what messages
parents are giving to their children?

Our study shows that between the ages of 7
and 11 children receive messages from their parents that divide the world into us
and them. This is exactly the age when children’s brains begin to develop the
ability to understand mental health issues. It’s also the age
when prejudice towards people with mental health problems begins. Our research
suggests that parents’ messages are contributing to the development of
stigmatising attitudes. It also suggests that unconscious intergenerational
patterns of parenting might lead to the persistence of these messages, despite wishing
for something different. This process could undermine any beneficial impact of
programmes such as Time to Change,
targeting as they do explicit opinions and knowledge. It’s clear that these don’t translate into changed messages to
children nearly as easily as we might think.

So what could we do differently if explicit
messages reinforcing difference are not the best way? Here are a few
suggestions:

Anti-stigma programmes should explicitly target
parents of young children. Parents are skilled at talking about mental wellbeing with their children. It
follows that an understanding of mental health and distress as part of a
spectrum of human experience, is likely to help parents feel more confident in openly
discussing mental health difficulties.

Encourage parents to reflect on what was
communicated to them as children might help them think about what they might
like to do differently. During my research interviews parents readily began to
do this with relatively little prompting.

Campaigns need to target primary school
aged children directly, in the media and also working alongside schools and
parents. Campaigns targeting adolescents and adults are too late: fear and
prejudice are already ingrained.

We shouldn’t rely upon campaigns and professionals
to begin this sea change. Each of us can start to make changes to how we talk
about mental distress within our own families. Take a risk: bring it up. Let’s help
our children learn that there is no us and them, only us and us.

Jo Mueller is a clinical psychologist working with
children and families in London. Follow her on Twitter @clinpsydrjo.

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The Salomons Centre for Applied Psychology in Tunbridge Wells, England. We are part of the Canterbury Christ church University Department of Psychology, Politics and Sociology. We run training courses in Clinical Psychology and CBT and also practice improvement programmes for child and adolescent mental health services. On this site staff and trainees in the Department write about a wide range of issues related to applied psychology, psychological therapies, policy and health service development.